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An Integrated Approach 6 ProgrammeWhoRole changeFocus Patient From passive patient to self-management Activation and partnership: confidence and skills Clinician From expert who cares to enabler who supports self- management Building the knowledge, skills and attitudes needed to provide effective self- management support Service From clinician- centred services to services that have self-management support as their organising principle Embedding the 3 enablers into everyday practice by building them into systems and care pathways Self-management Programme Practitioner Development Programme Service Improvement Programme

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Self Management Programme outcomes 8... producing statistically significant changes in: positive engagement with life constructive attitude/approach towards condition more positive emotional well being using self-management skills and techniques “I used to go to the doctor only when they summoned me, and then say ‘What are you going to do to fix my problem?’. But now I’m saying like, ‘I’m not sure these particular painkillers are working the way we hoped, can we try something else? What could I do myself? ’ “ Person living with a long-term condition Skills developed.... Setting the agenda Setting goals Problem solving Develop the confidence Understand their condition Develop skills

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Practitioner Development Programme outcomes 9 Practice positively influenced: patients’ confidence to self manage agenda setting setting own goals collaborative problem solving goal follow up patients’ experience Community matron Clinician tutor “It’s a change from the traditional approach where say ‘You need to do this”, and the patient says “you’re the boss”, but doesn’t actually do it. We used to wonder why that wasn’t working” “Now I use agenda setting with my patients and I start by asking ‘what do you want us to do today?’ Patients appreciate this different approach because you are giving them the power. You work out the goals and the steps together and they are empowered to carry on and work on it on their own. So you may need to see them a bit more at first, but in the long run you need to see them less often.”